乳腺癌前哨淋巴结活检染料和手术时机选择

目的：通过乳腺淋巴引流动物模型及临床乳腺癌来研究染料法前哨淋巴结活检（SLNB）合适染料和手术时机的选择。方法：以12只雌性成年兔第2对乳腺的淋巴引流模型来观察异硫蓝组，美蓝组和两者联合组淋巴结依次染色的时间，枚数和褪色的时间。在12例乳腺癌患者行SLNB时进行仔细观察。结果：通过动物模型发现，异硫蓝组和联合组淋巴结染色的时间明显短于美蓝组，淋巴结染色的枚数明显多于美蓝组；异硫蓝组褪色的时间明显快于美蓝组和联合组，12例乳腺癌患者中有11例注射异硫蓝后30秒－45秒发现淋巴管开始染色，2分钟内即可发现染色的淋巴结。结论：成年雌性兔是一种较为理想的乳腺淋巴引流模型，可用于SLNB的研究。异硫蓝和美蓝联合使用具有互补性。我们推荐1％异硫蓝行乳腺癌SLNB时间为注射染料后1分钟。

Clinical and Experimental Study of the Choice of Vital Dyes and the Timing for Sentinel Lymph Node Biopsy in Breast Cancer

To study the choice of vital dyes and the timing for sentinel lymph node biopsy (SLNB) in breast cancer patients and established animal model Twelve female adult rabbits were used to observe the lymphatic drainage from the second mammary gland to axillary lymph nodes stained by isosulfan blue, methylene blue and isosulfan blue plus methylene blue. Twelve breast cancer patients were consecutively evaluated after SLNB. The time of lymph nodes being stained by isosulfan and isosulfan plus methylene was shorter than that by methyleneblue The rate of stained nodes by isosulfan and isosulfan plus methylene blue was higher than that by methylene blue .The time of lymph nodes being faded in isosulfan group was shorter than that in both methylene and isosulfan plus methylene blue group. Blue stained lymphatic tract was found in 11 out of 12 breast cancer patients between 30 to 45 seconds and SLN were traced within 2 minutes after injecting 1% isosulfan blue. [Conclusions] Adult female rabbit is ideal animal model for studying lymphatic drainage. The mixture of isosulfan and methylene blue can balance the shortage of the two vital dyes in the experimental study. According to the clinical results, we recommend the time of SLNB as 1 minute after injecting 1% isosulfan blue.